Retained Foreign Bodies: Risk and Outcomes at the National Level

Al‐Qurayshi, Zaid; Hauch, Adam; Slakey, Douglas P.; Kandil, Emad

doi:10.1016/j.jamcollsurg.2014.12.015

Cited by 22 publications

(21 citation statements)

References 37 publications

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“…The provider is faced with personal, professional, and financial repercussions in the event of a RSS, especially in the setting of patient injury. Given that a retained surgical instrument is classified as a "never event", there is no defense from a litigation standpoint and the provider must shoulder the blame and consequences of the event 16 . Being responsible for harm coming to a patient is psychologically damaging and the results of the far-reaching effects on the surgeon have been termed "second victim syndrome" 17 .…”

Section: Discussionmentioning

confidence: 99%

Incidence and Awareness of Near Miss And Retained Surgical Sharps: A National Survey

Weprin

Meyer

et al. 2021

Preprint

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Introduction. A retained surgical sharp (RSS) is a never-event and defined as a lost sharp (needle, blade, instrument, guidewire, metal fragment) that is not recovered prior to the patient leaving the operating room. A near-miss sharp (NMS) is an intraoperative event where there is a lost surgical sharp that is recovered prior to the patient leaving the operating room. With underreporting of such incidents, it is unrealistic to expect aggressive development of new prevention and detection strategies. Moreover, awareness about the issue of near miss or retained surgical sharps remains limited. The aim of this large-scale national survey-based study was to estimate the incidence of these events and to identify the challenges surrounding the use of surgical sharps in daily practice. Methods An IRB approved and anonymous national survey composed of eleven questions was distributed electronically to operating room team members across the United States. There were 447 survey responses, in which 411 were used for further analysis. 36 responses were removed due to incomplete respondent data. The 411 were then categorized by group to include 94 (22.9%) from anesthesiologist, 132 (32.1%) from resident/fellow/attending surgeon and 185 (45%) from surgical nurse and technologist. Results. Overall, most of each respondent group reported 1-5 lost sharp events over the last year. Roughly 20% of surgeons believed they never had a miscounted sharp over the last year, where only 5.3% of anesthesiologist reported the same (p=0.002). Each group agreed that roughly 4 lost events occur every 1,000 surgeries, but a significant difference was found between the three groups regarding the number of lost sharps not recovered per 10,000 surgeries with anesthesiologist, surgeon and nurse/technologist groups estimating 2.37, 2.56 and 2.94 respectively (p=0.001). All groups noted x-ray to offer poor effectiveness at 26-50% with 31-40min added for each time x-ray was used. More than half (56.8%) of surgeons reported using x-ray 100% of the time when managing a lost sharp whereas anesthesiologists and nurses/technologists believe it is closer to 1/3 of the time. An average of 21-30min is spent managing each NMS, making a lost sharp event result in up to 70min of added OR time. Conclusions. Near miss and RSS are more prevalent than what is reported in current literature. Surgeons perceive a higher rate of success in retrieving the RSS when compared to anesthesiologists and OR nurses/technologists. We recognize several challenges surrounding near miss and never events as contributing factors to their underreported nature and the higher degree of surgeon recall bias associated with these events. Additionally, we highlight that current methods for prevention are costly in time and resources without improvement in patient safety. As NMS and RSS have significant health system implications, a strong understanding of these implications is important as we strive to improve patient safety.

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Section: Discussionmentioning

confidence: 99%

Incidence and Awareness of Near Miss And Retained Surgical Sharps: A National Survey

Weprin

Meyer

et al. 2021

Preprint

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“…Al-Qurayshi et al, en un estudio caso control concluye que también la edad avanzada, la obesidad y los hospitales docentes, se comportan como factores de riesgo que aumentarían la incidencia de casos (Al-qurayshi, Hauch, & Slakey, 2015).…”

Section: Discussionunclassified

Aspectos médico legales y quirúrgicos de los oblitos. Presentación de un caso

Chiliquinga

Pérez

Carvajal

et al. 2021

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Introducción: El oblito es un cuerpo extraño olvidado en el interior de un paciente durante una intervención quirúrgica, su incidencia real no es clara pues en muchas ocasiones no se reportan en el medio hospitalario por las implicaciones médico-legales. Informe de caso: Paciente masculino de 41 años de edad, acude al servicio de emergencia por presentar cuadro de apendicitis complicada, se realiza una intervención quirúrgica de emergencia, posteriormente presenta una fístula enterocutánea. Paciente acude a facultativo el cual evidencia a nivel de la herida presencia de cuerpo extraño, el cual es extraído. Discusión: Cuando existen cuadros diagnósticos oscuros posterior a una intervención quirúrgica la sospecha clínica de un oblito se la debe hacer seguido de la realización de los exámenes complementarios y extracción inmediata. Conclusión: La comprensión de esta complicación permitirá tomar medidas preventivas adecuadas y facilitará una pronta sospecha clínica con un diagnóstico oportuno y tratamiento adecuado.

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“…A study in the Journal of the American College of Surgeons found that retained FBs from a variety of situations are associated with higher cost of service and are more likely to occur in geriatric and obese patients. 5 Nasopharyngeal airways are widely considered safe airway management tools that can be quickly deployed. These airway tools are portable and cost effective, and are actively used prior to establishing a definitive airway.…”

Section: Discussionmentioning

confidence: 99%

One Notable Complication of Nasopharyngeal Airway: A Case Report

Briggs

Countryman

McGinnis

2020

Clinical Practice and Cases in Emergency Medicine

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Introduction: The nasopharyngeal airway (NPA) is used by emergency providers and first responders to assist with oxygenation in obtunded, critically ill patients. There are few recorded NPA complications. Case Report: We describe a unique case in which a patient went multiple days with recurrent symptoms of upper airway obstruction secondary to retained NPA. Discussion: Nasopharyngeal airways may be uniquely prone to being displaced and retained due to their use in emergent situations, their small size, and time of insertion in the field prior to emergency department (ED) contact where handoff is not often standardized. Conclusion: The use of large-flanged NPAs might reduce incidences of displacement into the nasal cavity. This case highlights the need for improved handoff communication between emergency medical services and ED staff, especially to account for all inserted devices to prevent foreign body retention.

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Retained Foreign Bodies: Risk and Outcomes at the National Level

Cited by 22 publications

References 37 publications

Incidence and Awareness of Near Miss And Retained Surgical Sharps: A National Survey

Incidence and Awareness of Near Miss And Retained Surgical Sharps: A National Survey

Aspectos médico legales y quirúrgicos de los oblitos. Presentación de un caso

One Notable Complication of Nasopharyngeal Airway: A Case Report

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